Dosage question for the experts

[ctyguy]

I went to the clinic today and had my INR checked and I was 2.0 on the button. I've been on coumadin about 9 weeks now and have been in range (2.0 to 3.0) for the last 6 weeks or so. My last 4 checks have been 2.4, 2.7, 2.4, and now 2.0

I have been taking 30mg a week (5, 4, 4, 5, 4, 4, 4) and its been fairly smooth. As I expected they bumped my dosage today 34mg (6, 4, 6, 4, 6, 4, 4). Since I've got the On-X valve Im comfortable with the 2.0 to 3.0 range, I know alot folks feel better 2.5 to 3.5. But given that some folks have this valve in the Aortic position and take NO coumadin Im not freaking out thinking Im going to have an issue right away. However I do not want to go below 2.0 as Im sure all of you will concur.

So does a 4mg bump for a week seem sufficient to you all ? I go back in 10 days for another check but want some opinions. Personally I wanted a 5mg bump so I would go (6, 5, 6, 4, 6, 4, 4).

Feedback from those with more self medicating experience is greatly appreciated.

Scott

 

[ALCapshaw2]

A 4 mg increase over 30 mg/ week represents a 13.3% increase.

For ME that would be a HUGE increase.
When I'm borderline, I usually bump my dose by 3 to 6 %.

I expect increased metabolism due to increased activity is responsible for your drop so something on the high side is probably a good idea. (I would probably stick to 10 % and see what happens but at 2.0 you have LOTS of headroom so I would not expect anything dangerous. Just check again in a week.)

FWIW, I am NOT a self doser or home tester.
(Insurance won't cover it).

 

[geebee]

I would probably just change 3 of the 4mg days (of your old schedule) to 5mg days and retest in a week. While I don't think you would be way out of range with the 4mg/week, it might be more than you really need.

However, if your activity level keeps increasing, you may need to keep increasing the dosage.

 

[ctyguy]

I expect my dosage to continue to go up, Im running several times a week now, doing ALOT more outside. I played golf yesterday (not very well) but that was probably a bit too soon. My chest isn't sore or anything but I can certainly tell I did something new.

 

[aussigal]

The last time I adjusted my dose upwards I was looking for an INR increase of around 0.5. I had been taking 5mg everyday and upped it to 5.5mg per day...I havent had to change my dose in ages now as its sitting perfectly in-range.

Small changes (eg: 5% of weekly dose) can make the difference you are looking for...having a variety of Coumadin pills in different strengths helps achieve this easily.

 

[ALCapshaw2]

Out of curiosity, what Pill Doses do you have on hand?

Having two different doses, 1mg apart, makes it EASY to adjust your dose over a 7mg range merely by the 'split'.
(e.g. 5 mg and 6 mg tablets would allow you to cover a range of 35 to 42 mg/week by taking only ONE pill per day).

 

[Philip B]

Adjustment

Adjustment

I find that my INR stays more stable if I alternate my dosages. Presently, I alternate between 7.5 and 10 mg on an every other day type schedule. My preferred range is between 2.5 & 3.5. My cardiologist has told me that 2.0 actually provides me with an adaquate margin of protection with my St Jude in the aortic position.

Metabolic rate has a huge effect on INR. It's typical to metabolize coumadin at a faster rate when one is engaging in regular exercise and/or physical activities. I fully expect to be taking 10 mg a day when I start walking a golf course regularly this summer.

-Philip

 

[Ross]

That is too much of an increase. I think your going to find yourself just over your range.

 

[ctyguy]

the clinic want to adjust me upwards by 10% to 15%. I'm now jogging 8 to 10 miles a week, something I wasn't doing 2 or 3 weeks ago. So I knew I would see an adjustment heading my way. I just want to be sure that the adjustment is enough, being at the bottom of my range is a bit nerve racking seeing how its my first time being in this position.

 

[Ross]

Well if your increasing your activity that much, then perhaps that change isn't out of line.